Osseointegration (from Latin ossum "bone" and integrare "to make the whole") is a direct structural and functional relationship between living and surface bones. artificial implants with load ("load-bearing" as defined by Albrektsson et al. in 1981). A more recent definition (by Schroeder et al.) Defines osseointegration as "functional ankylosis (bone obedience)", where new bone is placed directly on the surface of the implant and the implant indicates mechanical stability (also known as primary stability - that is, resistance to destabilization by mechanical agitation or shear forces). Osseointegration has improved medical bone sciences and joint replacement techniques as well as dental implants and increased prosthetics for amputation.
Video Osseointegration
Definisi
Osseointegration is also defined as: "the formation of a direct interface between the implant and the bone, without interference with soft tissue". Osseointegrated implants are types of implants defined as "endosteal implants containing pores in which osteoblasts and supporting connective tissues can migrate". Applied to oral implantology, this refers to bone grown to the surface of the implant without soft tissue coating. No scarring, cartilage or ligament fibers exist between the bone and the surface of the implant. Direct contact of the bone surface and the implant can be microscopically verified.
Osseointegration can also be defined as:
- Integration of the osseous, clear direct attachment or osseous tissue connection to the inert alloplastic material without interfering with the connective tissue.
- The process and produce a clear direct connection of the surface of endogenous material and host bone tissue without intervening connective tissue.
- The interface between alloplastic material and bone.
Maps Osseointegration
History
Osseointegration was first observed - though not stated explicitly - by Bothe, Beaton, and Davenport in 1940. Bothe et al. is the first researcher to instill titanium in animals and says how he has a tendency to join bones. Bothe et al. reported that due to the nature of the titanium element, its strength, and its hardness, it has great potential to be used as a prosthesis of the future. Osseointegration was later described by Gottlieb Leventhal in 1951. Leventhal placed a titanium screw on the rat femurs and commented how "At the end of 6 weeks, the screws are slightly tighter than when originally inserted, at 12 weeks, the screws are harder to remove and at the end of 16 weeks , the screws are so tight that in one specimen the femur is cracked when attempts are made to lift the screw Microscopic examination of the bone structure reveals no reaction to the implants Trabekulasi seems very normal. "The reactions described by Leventhal and Bothe et al. will then be incorporated into the term "osseointegration" by Per-Ingvar BrÆ' narkark of Sweden. In 1952, BrÃÆ'nn nemark conducted an experiment in which he used a titanium implant space to study the blood flow in rabbit bones. At the end of the experiment, when it was time to remove the titanium chamber from the bone, he discovered that the bone had fused completely with the implant so that the room could not be released. BrÃÆ'  ¥ nemark calls this "osseointegration", and, like Bothe et al. and Leventhal before him, seeing the possibilities for human use.
In dentistry the implementation of osseointegration began in the mid-1960s as a result of the work of BrÃÆ'  ¥ nemark. In 1965 BrÃÆ' nemark, who at that time Professor of Anatomy at the University of Gothenburg, put dental implants into the first human patient - GÃÆ'¶sta Larsson. This patient has a gap ceiling defect and requires an implant to support the obturatorumum. GÃÆ'¶sta Larsson died in 2005, with original implants still in existence after 40 years of functioning.
In the mid-1970s Brän nemark entered a commercial partnership with the Swedish defense company Bofors to produce dental implants and the necessary instrumentation for their placement. Finally, the Bofors branch, Nobel Pharma, was made to concentrate on this product line. Nobel Pharma later became the Nobel Biocare.
BrÃÆ'  ¥ nemark spent nearly 30 years fighting the scientific community to accept osseointegration as a viable treatment. In Sweden he is often openly mocked at scientific conferences. His university stopped funding for his research, forcing him to open a private clinic to continue patient care. Eventually the breed of young academics began to pay attention to the work undertaken in Sweden. George Zarb, a Malta-born Canadian prostodontist, is instrumental in bringing the concept of osseointegration to the wider world. The 1983 Toronto Conference was generally regarded as a turning point, when eventually the worldwide scientific community accepted Bremohnemark's work. Today's osseointegration is a highly predictable and ordinary treatment modality. Recently since 2010 Al Muderis in Sydney Australia used a high tensile titanium implant with a high plasma sprayed surface probe as an intramedullary prosthesis that was inserted into the bone of the amputation residue and then connected through a skin opening to a robot motion prosthesis. This allows the amputated person to move more comfortably and consumes less energy. Al Muderis also published the first series incorporating an osseointegration prosthesis with joint replacement allowing under the knee to be amputated with knee arthritis or short remaining bone to mobilize without need of socket prosthesis.
On December 7, 2015, two Operation Iraqi Freedom/Operation Enduring Freedom veterans, Bryant Jacobs and Ed Salau, will be the first in the United States to get a percutaneous osseointegrasi prosthesis. During the first phase, doctors at the Salt Lake Veterans Affairs Hospital will embed titanium stud in the femur of each patient. About six weeks later, they will return and install a docking mechanism for the prosthesis.
Mechanism
Osseointegration is a dynamic process in which the characteristics of the implant (ie macrogeometry, surface properties, etc.) play a role in modulating molecular and cellular behavior. While osseointegration has been observed using different materials, it is most commonly used to describe bone tissue reactions to titanium, or titanium coated with calcium phosphate derivatives. It was previously suspected that titanium was implanted in bone through mechanical stabilization action or interface bonding. Alternatively, coated calcium phosphate implants are considered stabilized by chemical bonds. It is now known that both coated calcium phosphate implants and titanium implants are chemically stabilized with bone either through direct contact between calcium and titanium atoms, or by bonding to layers such as cement lines at the implant/bone interface. Although there are some differences (eg lack of chondrogenic progenitor), osseointegration occurs through the same mechanisms as bone fracture healing.
Technique
For dental implants osseointegrasi, metallic, ceramic, and polymeric have been used, especially titanium. To be called osseointegration the connection between the bone and the implant does not need to be 100 percent, and the essence of osseointegration derives more from the stability of fixation than the contact rate in histological terms. In short this is a process whereby asymptomatic rigid clinical fixation of alloplastic material is achieved, and maintained, in the bone during functional loading. The implant healing time and initial stability are a function of the implant characteristic. For example, implants using a screw-shape design achieve high initial mechanical stability through the action of screws against bone. After implant installation, healing usually takes several weeks or months before the implant is fully integrated into the surrounding bone. The first evidence of integration occurs after a few weeks, while stronger connections progressively influence over the next few months or years. The implant has a screw-root shape design in bone resorption followed by bone remodeling interface and growth around the implant.
Implants using a highland form design (or screw-shape implant root with a sufficiently large gap between the screw pitch) undergo different modes of peri-implant ossification. In contrast to the above-mentioned threaded implants, the platau-roots form indicates de novo bone formation on the implant surface. The type of bone healing shown by highland implants is known as intramembranous healing.
Although the osseointegrated interface becomes resistant to external shocks over time, it may be damaged by prolonged negative stimuli and overload, which can lead to implant failure. In a study conducted using "Mini dental implants," it was noted that the absence of micromotion at the bone-implant interface is required to allow proper osseointegration. Furthermore, it is noted that there is a critical threshold of micromotion on which a fibrous encapsulation process occurs, rather than osseointegration.
Other complications may arise even without external impact. One problem is the growth of cement. In the normal case, the absence of cementum on the surface of the implant prevents the attachment of collagen fibers. This usually occurs due to the absence of cementum progenitor cells in the area receiving the implant. However, when these cells are present, cement may form on or around the surface of the implant, and functional collagen enclosures may be attached to it.
Progress in material engineering: metal foam
Since 2005, a number of orthopedic device manufacturers have introduced products featuring porous metal construction. Clinical studies in mammals have shown that porous metals, such as titanium foam, allow the formation of vascular systems in porous areas. For orthopedic use, metals such as tantalum or titanium are often used, as these metals exhibit high tensile strength and corrosion resistance with excellent biocompatibility.
The osseointegration process in a metal foam is similar to that of a bone graft. Properties such as bone from porous metal foams contribute to extensive bone infiltration, allowing osteoblast activity to take place. In addition, the porous structure allows for soft tissue adhesion and vascularization within the implant. These materials are currently used in hip replacements, knee replacements and dental implant surgeries.
Test procedure
There are a number of methods used to measure the level of osseointegration and subsequent implant stability. One of the most widely used diagnostic procedures is percussion analysis, in which dental instruments are tapped against implant carriers. The nature of the resulting ring is used as a qualitative measure of implant stability. The integrated implant will produce a higher "crystal" sound, while the unintegrated implants will produce dull and low-pitched sounds.
Another method is an inverted torque test, in which the implant carrier is opened. If it fails to release the torque back pressure, the implant is stable. If the implant rotates under pressure, it is considered to be failing and eliminated. This method has a fracture risk that occurs in the middle of the osseointegration process. It is also unreliable in determining the osseointegration potential of a bone region, since tests have produced that rotating implants can continue to be successfully integrated.
Source of the article : Wikipedia
0 Comments